From the Guidelines
A child with strep pharyngitis can return to school after completing 24 hours of antibiotic therapy. This recommendation is based on the American Heart Association's scientific statement, which suggests that patients are considered no longer contagious after 24 hours of antibiotic therapy 1. The use of antibiotics, such as penicillin, rapidly reduces the bacterial load of group A streptococcus in the throat, making the child significantly less contagious after this timeframe.
Key Considerations
- The child should continue the full course of antibiotics even after returning to school and symptoms improve, as stopping early can lead to treatment failure or complications.
- Parents should ensure the child feels well enough to participate in school activities, is fever-free without fever-reducing medications, and can maintain adequate hydration.
- The 24-hour rule balances preventing disease spread with minimizing unnecessary school absences, as strep throat is most contagious before antibiotics are started and during the first day of treatment.
Antibiotic Treatment
- Common antibiotics prescribed for strep throat include penicillin V, amoxicillin, or azithromycin for those with penicillin allergies, as noted in the treatment guidelines 1.
- It is essential to follow the prescribed antibiotic regimen and complete the full course of treatment to ensure effective management of the infection.
From the FDA Drug Label
Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever
The child can return to school 24 to 48 hours after starting antibiotics for strep pharyngitis, as long as they are no longer symptomatic and have been on antibiotics for the recommended minimum time. However, the full treatment course should still be completed, typically 10 days for strep infections, to prevent complications like acute rheumatic fever 2.
From the Research
Return to School After Starting Antibiotics for Strep Pharyngitis
- The American Academy of Pediatrics Committee on Infectious Diseases recommends that patients with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare 3.
- A study published in Pediatrics found that 39 (83%) of the patients became "culture negative" within the first 24 hours of initiating antibiotic therapy, suggesting that children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare 3.
- Other studies focus on the diagnosis and treatment of streptococcal pharyngitis, but do not provide specific guidance on when a child can return to school after starting antibiotics 4, 5, 6, 7.
- However, the general consensus is that patients with streptococcal pharyngitis should be treated with antibiotics for a full 10 days, and that they should not return to school or daycare until they have been symptom-free for at least 24 hours 4, 5, 6.
Key Findings
- Children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare 3.
- The majority of patients (83%) become "culture negative" within the first 24 hours of initiating antibiotic therapy 3.
- Antibiotics with narrow spectrums of activity, such as penicillin and amoxicillin, are recommended for treating strep throat 4, 5, 6.